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면역억제자에서 만성 B형간염의 예방적 치료

Prophylactic Antiviral Treatment in Immunosuppressed Chronic Hepatitis B Patients

대한소화기학회지 2019년 74권 5호 p.258 ~ 266
윤아일린 ( Yoon Eileen L. ) - 인제대학교 의과대학 상계백병원 소화기내과

Abstract


Improved management of chronic hepatitis B patients with oral nucleos(t)ide analogues has increased the number of these patients who are getting older and have other accompanying comorbidities. These comorbidities frequently require various immunosuppression treatments and/or cytotoxic chemotherapy. Not only the patients who are positive for HBsAg, but also the patients who are positive for isolated anti-HBc are at risk for hepatitis B reactivation during immunosuppression. Prophylactic antiviral treatment with oral nucleos(t)ide analogues with high genetic barriers can decrease the risks of HBV reactivation, HBV reactivation- associated hepatitis, and mortality in these patients. It is crucial to screen HBV markers in all of the patients who have to undergo immunosuppression, be administered prophylactic antiviral treatment in the high risk groups, and be monitored for HBV reactivation during and after immunosuppression and/or cytotoxic chemotherapy. This study summarizes the recommendations from the recently updated guidelines from Korea, United States, and Europe.

키워드

Hepatitis B, chronic; Immunosuppression; Reactivation; Prophylactic
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